Transcript of 166-12c-1_serial_1_section_3_56-la-156_la_report_6.9.68-part_4_of_6.pdf
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DEPARTMENT OF INDUSTRIAL RELATIONS
D{SION Of iNdustrial^ccidefts
WORKMEN'S COMPENSATION APPEALS BOARD
STATE CALIFORNIA
Case No. 6714 312 14
S23S? St304
NOTIcE OF HEARING
Apblicent
Vs:
02n7A 9ZSI] 1 RTO
438638UZ 3800437 CZZNEg, (8027050602
Defendanl.
You are hereby notifed that an application for compensation has been fled with the Workmen's Con pensxtion .FFcxls
Boxrd of the State of California. You are furthcr norificd that szid application hzs bcen set for hearing 1
4107 LOS ANGELES STATE OFFICE BUILDING, 107 SOUTH BROADIAY
LOS ANGELES, CALIFORNIA
ZR 823357 9805 AoM .
and-that 3 [ szid timne and place the Workren'$ Compensation Appeals Board will procecd t0 heir 1n4 of thc sil
#pplication in the manncr prescribed by law.
WORKMEN'S COMPENSA TION APPEALS BOARD
Fy
0
Dated 3t: Los Angeles, Glifornia
NOTE: The pirtics 4} expcctcd (0 submit &/l disputc? issues for decision Ji this hearing: All #itnesscs evidence, medicsl reports. FJ}roll: JnJ achc:
proof must bc arailzbl: Jc thc hearing: CONTINUANCES WILI; HE GRANTED ONLX UPON 4 CLFAR SHO#rYc; 0F Gt} ciL/
Requcsts for continuanccs acc 80 Hc mada witlin of the dute & this notice
NutE To INS(' RED EHPLOYERS: Yvur !!t"tlslae Jt this hesriu: W4} Mut be uc_Gu(} AL )u muc;i & 0rmJu
SER | ED) BK MAL ON PERSONS S/ >V"1"
ON TWE (FFICIAL ADIJRESS REcOR')
[)e: Ki;
9/8f51 J erz
772
J0A My_ 11;0i
J6 K6T" A;
OF
03
2 0 3 Yys
disiose
V/6 7
day'
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ARGONAUT AMSURANCE
FROM DATE_ 19
ANJURED k 4L iK
POLICY
INSURED_
EU Sezyz9
POLICY TERM
CONYERSATION with
LLlee
CLAM
2 03Yy__S
Akn Glu
Htlitte
€z
edln
773
ClM 067 R;
Lt8d
~780
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fvgrst 18,2927
Sirbap
B0%} Iovara 9
Jongja, 046
CE &8463
ASRIEIZZq 0222e
0
83E243 & ZEV 27
9723766
#op6ub0r 541967 -t3rd0
#06 Sef9.
Ftozwch %0 dcirirer GoDo
~opt 62 DorGo}
anelcl,Coliio
S} & &2
J0 Pt
2
08 nmZgor "50
#olxjll? 7r0, Dlty &
0*
#l08
03 330 Borr 62.8 . Axtached firi cncicw &2 Ot Tzlicel 7rprrt3c
In cleckirg %e @cctcc he tcli 4 % Old 83 4a
On his rcports :1 the & F80 unconocicuz
FUABZ TONNAZDD FTIR CCPIES ( IOTE IEPZZ:
781
UXr,
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INSURANCEREPORT BY MEDICAL RECi KDS
l
DESCHARGE DATE 9-26-66 CASE NO: 1988
PATIENT NANE: SLRHAN SIRHAN DOCTOR: RRlelsan
FINAL DIAGNOSIS: 72 82467 223 S@sE
0f23
Eh~ et
CONPPLETE NAMES OF OPERATION: 2ez 2<
DATE 0F PROCEDURE: 2_2-62
SURGEON: ASS ISTANT: ANEES :
ANTSTHETZC: ST AART OPERATION: START
STOP STOP
COMPLETED BY : c SUAMy-LpA_CQqicn _
71/67
0-k-66
782
A J :
fi
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BENJAMIN E. KERNDON, MD:
RICHARD A NELSON, MD, FAC.S.
JOHN WM SCHNEPPER, MD-
760 `SOUTH WASHBURN
CORONA, CALIFORNIA 91720
(714) 737-5892 C (714) 688-873 1
August 3, 1967
Argonaut Inso
443 Shatto
Ios Angeles, California 90005
Attn; Mrse Steiner Re : Sirhan Sirhan
Dear Mr8o Steiner:
In checking with Dr Nelson in rogards to sending you additional inforation
on the above named pationt , be tells me that O are unable to do So wi thou:
the vritton consent by Mr 0 Sirhane If you would send us hls consent then
WE can sond YQu the information you need provided wa have it on handa
Thank you_ 7
X_ Coffoy 783
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"*E 2 OROVA CoMmUnITY HOST
8 12 Vash?'RN AVE
~; CORONA CiORNIA 91720
PHONES 737.4323 538. 029}
~ErUi(EL _
ER 4985
4
RMi DATE IlMi 0
M
4~RESS CPIEF complINT
6. Industrial %cidon? ,
L8 rding recf h+76
56 he: ran Snt? fene & dnd tainixg
Ciii OF' {iRTm PF NE 33 3s follows
Sc IA[ SECURWY No
RBDONSIULE ?RTy TREATMENT
AC RLSS
EFLLOYER Nr#akwla'
KOURESS 3
0lvr
WNSURAN( E <6 Taceration 3 left upper lid (zeJiai)
AUORESS Bttarexai gaud Foreigi; Vodyes io evrs
GROUf' NO CERT NO {seerarion 3f 'chin; toizlex, 5' Cm {Sff]
ACCIDENI (NA URE; DATE_WHERE' Large coal#Ficm 01 dorea [ bsck
Contuelen x Jeft kand
#ltiplg zbragien8
(} " HZPERTET given
EMERGENCX ROOM CHARGES '5 04 #ospttalised-o1 further cte
J501J.L sc]~
Nonbul '16 17
00
FRUFESSIONAL EE
Sub TOTAL
A" >4. < 7 5
7ale
Je L[ 45 92
"4 42 10
80
HBORATORY
JcML Disposition xospiralized
NuRSES 5le JLURE Phxsician 4 kichard A. #eleon; #;:
CONSENT FoR TREATMENT
wirg " sehctny 17 4 "3 Jiaymos. Ju p#ol c( ~ Jitc: Iedlne heret, JiJ: 30st 0
d 3qu1 I0' "etc " " #Cma "soi Jke snec' Ike Gxrn: 3. 0^ C
4 bJgt' 1 In1'5 Ke n M{0 J'oir 7< "Jm :
"l "aj iI Y; Jisc {Jo 348 300t
6t Ae M1v' 42 c
6" onj
Signed for
Po"et} by
'REASON Noi SigNed By ?atENI REIAIONSMF
Toh
Riicineg} OEeicf
fell:
-32
i:
{k2
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ALBEFT TASHMA, M. D.
6753 HOLLYWDQD BOULEVARD
Ldg ANOELCB, GALIFORNIA 90020
TELEPHONE 466-4285
OPATHALMGlDGX
Arguo€ 18 , 2967
Argooauz Inguzance CoupB.V
1001 Wilohise Boalevazd
Lo8 AAGeleJ , Califorolo
Acceacion? J. Da Sclner
Re: B2sb20 @Isgkni
Clazn} C22 20245
Cur fzle8 67-2001
Dear Si*0:
At tbe rGgwc8e Qf tise cesrLo tho ebove Ranoz pBeione Nos
aramined E2 on Avgusc 25, 1967 0
BEST LLXUESE
The folleaing i9 a0 eccou36 O2 en aecidca: walch- @csuzzcd @a
Sepccaber 25 , 1966 28 8 A. Mo
"tzhe rezalrs' 02 cke @zd dece I 1ag br0o82"g @ EAR1y . Za o8nC2
worde , I |e8 a3kLng hez 8o 219/88 Esr 82 pba coulao 3 Dab
rlaing che bozse. % Ea3 0 vezy
Eczgy Eazatng ehag da7 4
fcu @egonds aftc1 3 hed cesrced &ho EiLly 1 W38 @ZE38& 8h8
threw @Bo % dor knor bci3 I fel&, TaCa, evaryrales Ez€
blenlto Zne pecplo Fio Moro
Faccb?n3 2o coulda € 063 Exat
bappened &xo :0 the I [g talpan by abulnneo €0 tke
boepital
0
Corora Coruzey Eoop?ealo 2 C2o ercaccd By Bzo
Richera Helacna Ee bad 8pplzcd 80n3 segecac3 68 Cbae 63
claised EQ3 azcecaie bleedisg. Ee
~Gp2lcd abcue chrce
€o
eaa Lorar Bidq 02 w ching &82 E &3" &m *u Czg i2 &ka
left aye. They tco< 8 8erias 02 Z-38789 and 88 kkak &i2a
2 [25 rot
Eully con3eloug
~0
1 #cazccd E0 6222 {00 Ekza 3 Ecle
tic colctcoo 02 the plaecora oz eable chcy bod pre Ee 034
I realiscd 003c6hleg A0 BORG Mie 2v GC3 88 cko Ezzac I
aearted €Q Cp1e Bhen ba Bea2€2 t0 {ega€ ghc s6icehkng
785
604
Dy
9%
:080
6o9
1 411k1
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Pago 2
Sirbae
8/18/87
EEZSENT_ILLNSE coze"d:
naedlo In Ey 67@ &rd I oza OE Leso Ead Eich azairzc cea60
I didn'€ like &he ctzeeb t0 bo puc ckeroo Fa Ingloted Ebae
Lc wJo acabwary . 1 d0n BESwi €ha g2071ty 02 cba (zrind ,
Intc 1 thought ir wasn ' € ncaobbary 60 be Bteceiedo 1 ceelds' €
80@ eaalz_
9
end h2 Juse cold me I€ [i33 DCCBCAzY 0 Ee Ezzte
to keep ,me In che hospltel for 2
roal: , B2 1 &len' 81ke tha
Ldea. 1 &d Atay overnlghe _
0
0
As che begrory w22l 'ndlcace) cha paefeat genblkd d b26a
I esked cha paetent MRaz ke bnc about 0B34 belng %5 has
Cjow
~fecr the &ccident nnd th:n 1ng big reply.
"pr , Neleod Fhen ha prc tbe ct1eehes {0 Go I coulda' €
poa tha Ge 68 8e3 anyhedy G8 co the Band t uy cyeo 2
had €c celz Br. Nelson 6o FCzsve cbo 80d, bait %e Cold Cze
o8 ehe #ureca afcertarde and 0be keok easo @2 ehsCo F
Wich regazd co the 8ubECqucnE crezcucac g@CCIved $ ebe pecicae
5a8 2 liecle vaguco Having roviozed eha nadReal 16 FaS
@pperene chec tlie Paclene bad bejz ereaccd Sor 0
choze pozicd
of tima ond digcharged by Dgc Belaon , eed be gba zecuracr
co Br . Welcon wich complelaca, and chc Laeeer zeforrea bim 80
er eve, @ar 0 noge and chroac Speclelkaed Dr. Yael NLLEcon.
When 1 Qokadl the pacsert ebaze ch2s polag, ehio {9 Whae bc a32d.
wirq exying cQ AEzongc chae copo?aeraae dacc:_
becweez Dr. Nelgon ard Dr NLlaGon0 eios %e had €e @ko Liz€
chroagh &hc 0fiee wnich took alore €ra wzesks @2 63. Ze 63
8 Daccer 02 ErysE Cq gee 23agCczet_ Br Woleon Egparcael]
considored me diseherged beea:o [8ca % [jene &337 8 8e0 bia
egaia he insczreced hif Occzeenry
88 ccbeect tbe '@z8n7 85'
reopea cha eccotine , &nd ho iia no€ Det O% Erta: @2 BEcer 2ha€
einZil be reecived the 0 6 Erca ebo Cczp8zy c f8
The patien€ Surcker @tczed:
f8 D5 Mflaeon &d2" & C0 83ych?ng, Me Jese C230 {18882272
{n py @er and up ET roJe ard gote Ra Derc
PLlo Malch zcally
didn' € do 4 chsaga Ko referred p3O C3 tho spocialiet, WEo MLton
726
9€
E
Es180
rzhey @ace,
ko
Pee
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Pege 3
81cban
8/18/67
BRESERT ILNESE coat'd.
MiLlcr
0
Ea agai7 gave Ee ecoc8 ,&ad 4283'€ d azrhinz
28 Eer a8 treatgne: 9 2 523 lrndcr bee caxe thrc3 Q5 Eorr
via2E{ . Ab3ue 8 mzth Zacor be gald I Ebouzd 003 B2 . Ketao
beceuse I told hir 1 had roved froz Cozana and back Eo Ey
originel addresg
0
Firot 02 ell he (Dr, KLeha) Bokzed {2 cocze wcza @Ij brokcz
boxee La tbi9 regicn. I eold bic 1 822 no€ Eroro Fe ordered
rraya caker , Be gave 0e 8 eRaLl tube 08 Doze Jubriegae eE4
that 548 8 eemlc type, end I ued IC, and 26 gan out uebin
8 weekt. Ic didn't ae8n to belp muctio Be didn' € Bay exytb?eg
@e 02? . '
I elco eskod &be patzeac alodlt 613 recarnendatlza 6? Dzo
Eieta ehe: bc *e 8e0 by 0 roxk tBlsbeDz nEed Dr
0
Bobert
Yiekke . Ta petiene 8tamazized €hls aleuaeioa f ehe Eolloalss
wey :
'Tbe€ 028 0 wezy abortive acrCzp€ by D%0 Eietc: 2 Eeleca
chzoa #oweha afke: D% . Bloki told Eao Ze bogu'€ Cr33o 1
newer 8a5 cha Dexzosucbadrg 3 ncver Eccelved Ehe RotEce Eset
che Jnmurguc@ Co34pazyy
0
Da (E2 . Eiahu) haco'& d8charged BB,
ha 8af4 unttl 1 se tbe RoEogUczCO3 $ 8e8 2& yet 2 bove po€
8e03 89 bcM ean L g0 beek €o b:oo &
Wieh rogezd g0 cbe paezen2 PzcBce . BypEBZ3}
D
ks elleges che
followleg8
"ery Ech Eackel #laecufozt. Tig Gyc % cin'€ :oeace
830 eigat _
0 % can' & Lcgk {n koth &zczeion8 29 I uacd €9 2
depending O1 eme poaiciod 02 E bce, 2 ea5 € oblke che
ger6 baek ond fozzko % Bevc 814 cszplais aborc ehe v18goao
1 BcCn t0 Eaz} cbe e2da vioieu. A
%a pacloae Eugetor Indseakca ekge eEasg bad beca
23 {Epg6vcza2
{8 blg condieiwm B&cec hle aceidcnea
24S Eaky
The patzere derle: 0z7 b.gtory 62 7oalfLccnc 66 Iajesy
02 digecoa Brior 30 810 abwo datr*02 %Jizy
0
797
bioo
00
{e0
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2830 &
8irhan
8/18/67
PABZFESTOEZ ccnc'&
According co 'tke paeLcae 8 tazeerzeccz !otez Vealale
Operator 8 licenge 5ab Lrgucd co bio %2 1965 43 Pagedcaap
Californiee
EAN"EE_ERSZEEZ
Zhe pacLena denles any fanllkal higtory Of cealar Cgca80.
R3Z @E EAICAL EZE
Zhe follorlas recorda ware Bueneeeed Zop Ey' scic4 @t ehe
clac 02 Crem95aEiono
20 Eoctor'0 Firse Repore 02 Woxt Injury dated Oscob32 6. 19669
Riekard 4o Neleon , Ma D.
2 0 joczoz'8 Fizce Beport 0f Boxk Enjuzy 0 Novcaiber 8, 1966 ,
Richard A, Nelson, M D a
30 Boccor'8 Fisat Reporc of Eork EqJuzy , Bovcmbez. 220 1966,
Paul N:lsson , Mc D,
10 boceor
Eizot Report of [ork Eadury , Apzll 3 1967 0
Cordon Riel, % 3 .
5 , Leceer €o Argonouc Enguraase COspaEy & AprIl & 1967 , 2o
Gordon Riet, Mo 2 ,
6 0 Leceer to Ergorsut Enburerca C3zz891 0 Cceobar 26, 8966 ,
Eichard 4: Molson, Mo De
Xhe Iniclal reporc 02 De . Rlchard Aq Helcon iedleseea &ae
cbc Lnjury 60 iin2eea 80 0 Grall Lcecracica 0? cka Lege
upor eyelid, Ex udezelon caere 538 errd %5 bozb 6ye8 _
6
Sabaequen€ Gvaluacicn by B2 _
0
Wlloeca e2n21rzl thege E4n3.i2gs
end Eailed t0 dezocatroco Ebo pregeoco 02 Bry_82eLElceze
oculer injury
c
788
90
14
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Pege 5
SLrhen
8{18/67
BIVIEI CL_MEQICNA ?ZL2 coxe 'd8
The rezore 02 Brc Eehd 28 Lu gengral pcza€Ive, bowovez 0
he cchuent8 O5 an "Sncongtant" conocrLegzon 02 che vksaal
fLeld and In addicion refezd Eo a Elbrowlc band i0 the lefc
"Pper which he feele uybe Che esuce @8 tkz pae_enc'@
L11 dafined Byus?Eom8 & HB . further Jntiesee3 tkat ekla eosdelon
night require 8urgery .
Tbere ere B9
ocher ophthaluologieal zcports 02 agaLflcance
in the; Elleo
EIAXINATZCU
VIafon 20/20 Neex : Je2 (Riebz Gyo)
20/20 J-2 (LeEe Gye)
External Seructures : There 1g D0
epparenc 8carzlng 02_ eiehez
eyelide Tba ocelaz aalaczac ad globes
820
gros8ly uezac_vGo
Etra Oculer Musclee : -Groesly incacto' Be diplopla dexoaatzezed ,
Puplla8 Boumd 8 regulaz and Gqeal deh gezual zesezloas 0
'Lactile TeagZons : Boch eve : Woc @lezecedo
Frundz: Tha pupila wera dlleeed; eka {kndl waze 8*d2ed wieh
boch dlrect &d Lndlgec€ OpthalroBCoDY . They 102 &
Eoues to be congigtent Ileh cko seated a30 (23}
Slit Lerp : sornea,
encerlor chawbor , Len8 , end cteeior +IEz8388
Bo2 renarkablea
Befraceion} 8e 8ignLEea82 zeEzagel0 `czzor &azastraecd.
VSsual Eleld Serecning: The wIeaa} ZLeldg 0€ ghla patisae Eare
Irvvoaelgeeex u9393 Eorz @Eferczie Eszaodg
Initially,&2J Eielcne (ag chcelze wZzh the
VLgual EZeld agzeclrg ec7lce Irhlch
789 Ledleaced kho elghe 6yo_ E38 nouzal and cbe
Lefe ega b3f 0o23 porlpbecel conatrLetioro
Rv
eyelid
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Page 6
Sirhen
8[13/67
EIANUNAZZCL cone 'di:
Vigual Field Screcalng CoRc 'd :
The ezal_natiog a: thca reoe3cc4 a€ &bo
tangere 8creer
uszng bozh &h0 4/1800 Ecd
2(1000 Wnlec tazgets . Taie dCanzbesaecz
mazked ccnaerieeloo 02 kolh vioual gKole? p
bue pore 80 In the lef: Cye @ban La cba
righeo Ic Bhould bo notcd thac &be @ETk 02
conetrfeeioa WIeb tba tro dsEfcrcre casgecb
Wa3 Kot Proportional to tha 0330 @2 zhg EaEEOg
uged 0 "The e3alnae2c3 E;98 Ekea eoEclezed 08293
che standard peeinotaz_ 2hl9 ka8e @haered Enderaze
conotciccion 02 tha rkght gzak ow EaS#c 632"
erietzon o2 cko Legt ZLeld, Eaow ck? varlons
{Leldz are cozqazci, ic 10 Olvioug tba€ the rezalea
are highly: LnconoEbteec an % RS [CIy Could t3
roleted to any OFgBnLc ps0cc38 LEvolvErg ezchor
the Gyes or the inczd-Gzendal vical pocbr ayu ,
Stereopaiss Pacient hae nozul bieoaular feretzoro
2ZAC2BZ8
Eseentsally norral wye exsalaat%ezo
CTM@ZZ
Baged 03 DV exanina:: OL , che bigcozy obealscd) pE4" the nad:eal
recorde prosaatly AVAfLeblop 1 d0 Eve bolievo &hae chis pee_ene
austained a%y pericaccne dLsabzllty 0J 8 secale 02 Eho @eeldcae
'0f Sepctabez 25, 2966 .
The Ljury to the Lefe ueer cyal:id rafozred 63 %5 Gthcz
Dedieal Gonlnatioa :9 nor dezongkxable 88 &ba DscoGn2 {Lac,
erd 2 8ezongly 0dvi80 RgAln3€ AnY QEECIDE to rocagt 0
sgicnl
lncezvc8tkoz. Zh:s paczone , In 4y opka801
0
bos eha %Lghe
conblnacion.Qf Ecetcro Co Karrane EtC0 Conaarvatien {5
ucillzing any thezzpy9f.thss nate bnnely bg-b2?
3I
790
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Pege 7
sirhan
8/18/67
waicb ere noz Organic in 0z1g89, ena in addition bn8 2?
Proof phnteoever chec &ny foresgn macerzal L8 zccalned In
tbe lefe orbltal &re8.
wich regarde tD ehe syzptoma &lLegcd by thle peticat
9
ckere
18 Dothing taesocer La che peclenc' 8 ecgnlnatioz :w 5u3-
atanciate 8 clain 04 23 ozganlc' 1njuzyo Ao xatod 'abrre,
peerly all tha Gubjective cegta 02 v:Breal fumatioa have
clearly dccoascratec 4
patcozn of Loconokscacy whlch ncgates
the poggibflity cf any injury tC &be eyes Or ehc Entre-ezedlal
vioval pachrays 0
CONCUWBECE
AB 8 g@gult of the abrve scorted {Aluwy cialo paeleat @a E€
suezein 9
peznanent: dicab2lley involving his Gycs. Bo fureer
nedical creatmonc :& Sxdlleaced 88
che paeicaz @ coudzee3. 38
noc
indugerlelly relaccd.
2 Wlbb E0 chanl: you for thig referzel; ahpela thcze be eny
ubangwered questicna regarding chlo cc8e, pleage do pot beszeaee
to call on 0JG e
Very truly youto
0
Albazc 'Taskaa, Flo Do
A/rs
Encl.
791
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ARGONAUT MASURANCE
FROR
Zlls
DATE _
FZb
19
NJURED POliCY #
INSURED_ POLICY TERM
ConvERsATiON Yitk CLAIM
X_o3xys
ZZ
Z
Lly 0
792
ClM 547 R-1
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AT
7*2&-61
3/fW
DATE I 7731233
2x_Re3sy
zxz
YlaJE
L
1e_LLs E4e44_b
kukes_Qauitkc 21
AxhLL_A
2o_DZB
Zy ARo?NAIT INs4ANC?
PLEASE EPLY To
SIGNED
UsDn: al
GEN 6o6 IT
Ycs
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ARGONAUT INSURANCE
To_ FROM DATE_
2.-77
19
INJURED Policy #
INSURED POLICY TERM
CONVERSATION With CLAIM #
774-7375547 Ax6e?
ZLezzzz Exhee c Li ZZ
ILL Lu42 LLleCrLL@_e_s
C(2e
(eele<A
224x
LE/ Yz
Y+c
L ci
76U_Y
794
ClM 527 R-1
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ARCONAUT INSURANCE
To_ FROM DATE_ 19
INJURED_ POLICY
INSURED POLICY TERM
CONVERSATION Witk CLAIM
4e1s
5
L3c4s
795
cli047 %
Jeju
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McLAUGHLIN, EvANS, DALBEY & UMMING
ATTORNEYS AT LAW
JOHN F McLAUGHLIN 1717 NORTH HIGHLAND AVENUEJ SUITE 710
BARRY F. EVANS LOs ANGELES, CALIFORNIA 90028
(213) 466-8541
WM_ BLAIR DALBEY
RAY B, CUMMING
HAROLD J_ BENNETT
NED L. GAYLORD
July 20, 1967
JOHN F BARTOS
GEORGE R, HASWELL
ALLAN R SCHUMMER
ROBERT H_ GILLHAM
Workmen's Compensation Appeals Board
107 South Broadway
Los Angelea , Ca llfornia
Re: SIRHAN STRHAN V AISILLISCH CONSTRUCTION C ONPANY
WCAB File No. Appl dated:
'Juiy Jo, 1o87
Hearing Date:
Gentlemen:
Your attention is respectfully invited to the following:
Attached please find duly-executed Compromise & Release for your approval,
Request is hereby made for further hearing to permit cross-examination of
and presentation of rebuttal evidence:
(xX Please enter our appearance as attorneys for ARGONAUT ISURANCE CQMPANY
Please case for trial 25 there are nOw issues in contest:
SX Attached for filing herein are: MEDICA L REPORTS :
Ee Gozdon Kiehn; MoDc Apzil 4, 1567
Fs, Qcrdon Xleha, M,Do Aprz} 30 1967
Pael Nl188on, MioD o Mcvesbar: 22,
Rlchard B & Nelson' HDD 6 November 88 1956
Robord A& Nelson, MoDo, Octojer 269 1966
Riebara A. Nelaon? . MoD)u October 6,
AXSKER
Copies to: truly yours,
Balner & TToomcz
16 Ne Marengc Aveo , Pesa McLAUGHLIN, EVANS, DALBEY & CUMMING
9
Argoneut Ingencq_Covpany 793
Cleio No: 2x 2-3445
By:
Bo Cunukng
2ozwk/5
set
1966
3956
Very
8u 7
Rav
==================================================
Page 19
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McLAUGHLIN; EvANS, DALBEY & CUMMING
ATTORNEYS AT LAW
JOAN MclaUGALIN AREA todE 213
BARRY F EVANS 1717 HoRth HighLANO AVENUE, SUIte 7i0 Telephone
WM.BLA TR DALREY 406-854; Los ANGELES, CALiFORNIA 90028 RaY B.cumming
HAROLD J.BENNETT
NED GatLoRC
JOHN F. B4RTOs 26, 1967
GEORGE R_ HASWELL
ALLAN R.SChUMER
RoBERT MGILLHAM
Arseraut Ingurence Cowpany
4631 Shacto Pleee
Lqs Argeles, Cal:fornia
Actesticn : R, Ja Fobbinc; -Claim3_Ezaminer
Sizban Sirhaa W , Crenja .Vigca Dal Rio
22-203445
IA: Sepcember 25
9
1966
Centienen:
Re bave revleved the above ce8e referred t0 0ur' office on
July 20
9
1967
0
We noce ' &be applicatios 118€8 che
Gp loyer
88 Cranja Vista Del Rio where3b the CHp Zoyer 8 report
refer? to Alcfilliceh Conscruceion Conpany
0
Ycu have
indicated you Jngwzed thle perticulaz conatruccion
ccmpany but di.d 7ou 8l80 Jnaure Granja Visea Del Rio?
If Yo1 @0 {n' Sact covez tnt8 entity, shen we recozrend
You irjediacely sed 8 Zerter t0 rhe applicanc acvising
him Coet &l1 Medicl treetuent 18 exehorized by eichez
Dr Geraner or DEa Neaver O2 wnczever you Incend *o 038
for this Durrose Jou shquld al3o advi8e hin chee_83y
orhez msdicel {0R Jent Mll be cn 2 selz-procured basi8.
Tre Siiagce-col= roquescs Pezzoda 32 dz8b3338,'richoltz
buc only Fnrlous 02 018ab.l18 wichoue
0 specifyingc We Srcge3c You secure 8 repore fron applicgnc
8
Superioz a8 tQ Mneger or aot he perfozmed hlg regular cuces
after September 25, 1966 , chac 18 he conzinued €o mork
for chen.
IE you weh to 8e* P enother excnirtion wich Dr_
0
Garzer ,
0 we C3n
undcubcedly
Secur0 tha licanc 8 8ecorney 8
cooperacion {1 ccipelling bis
cxaic
:o atrend ,
Vory truly yowr8
0
MeLAUCELIN , EVANS
9
DALBEY & CUNNING
(vn~ep
B7: B. Cwuing
RBC;g
797
July
LS ,
'35
321
==================================================
Page 20
==================================================
ARGONAUT WNSURANCE
To FROM DATE
4-7
19
WRJURED_ POLICY #
INSURED_ Policy TERM
CONVERSATION Mith CLAIM
Zx - > 03XY_
2Ly_23z-122S
(Evsy_ql.stss Rx_
~ls-k_
62 LLUl2
3EyL_
4z &
~shua
SiE 2ec_sky~lzs
us LL_Lus_ ,kik
4o44
Lx 4zs Cu
@_ Fey
798
7z62
Ld
==================================================
Page 21
==================================================
To
02(.n Kos_Szaug
SUBJECT DRTE CzL1e
2-2767
2341
i4%hsu
KeI
2L @}
Ldseel/+2_ Li
'Hs Y-LhY
ZL Zex
Za> 2EEEalAZZe
LiAA
ZeAZLe2FZ
ARGONAU?]_INSURARCE LEAADA_LLLLLhe
PLHAS} REPLY t0
ZZ8
SIGNED LuIC
Uso Rorersa Scie Vox Fox; Reply
GEN 508R2 4
An R
==================================================
Page 22
==================================================
98k <aajcuece wfvamies
cly 1S1
fkttillierk oroshior CEzJo %reo
Brz 37CB, ECrko %
Carcuaa C22220328
GREia %3od 03 2313
Clast;art; 13 812622
1c cr 044778 s1&/65
036825228
48 9cz %1J4 {70 Snz0c3 231c488367320900 Di0b 03 Eozz 8
CooCrnau40A5r3 Br3zo7 Crmocul2s %4 62 0 3031l8 CI 248
erplcyn:;; %i44 75r b3 Grsroirzd @ %0731 % 188 3c28
CTJ ezi 1c.ep bek &R:
37e772.
18 (3cR Zo:? %0 $$ ko Gila &0 Gxnr JauP G E8028
ERZZNT #4C0 $ 00283 0273tica &30 %3 {383v 3E0240 C8 JC3
634 Go: %h3c %C3 0820 80 @J 63 CCoD C3 0o723020
Fc 0224 t33 Co10ssrtz #8aEr}cc 5713
r0cc22 0 {7*924 325 #0 Lirol #rrr 7 Gziedo
{erorx 3oe&7m Jcjvlulz YCnI CCIPIJa #3Cri}
4
5o33 ho rocolvoi %1 033 rczicl 02 223 W%23 73o} #3 7c12
CCNIRZY & 074 31% %1ric87 @2 %20 %3 00ricd {o7 jo Crllic2zb &)
Nc 13157 6 %/23766 Er] 4 7G1433 071 %i7zo s} Cr 8 0rav}c13
sjy %0 240 ioeprCnl G Z020 (zo
I} fuicigesic? & 672 Grzoy zope I7 #t7n2 Fou E0v 8071? {n3 Co-
0p77jiicn % % %271255 82 &i8 E78830
VCzy 076} JErzoe
2 % 2eiz%
CJ3f 373333
E3:_
Cr: #0; 3elbcz 62zz
sjJ-fo [
20
529
==================================================
Page 23
==================================================
SGws %ata 9.92
BCARORN; BRE AKING
(AY UPS TRAINING
SAlFs PREPARATION YFARiiMGS ConDiticNed
OFFICE 17 141 737.5375 132c0 Citrus AVENUE CORONA_ CALIFORNIA MAilING ADD RT . 1 BOX 1598
21, 1967
7, J. Robbi s
9
Clains Examiner
Argoneu t Insurance
445 Shatto Place
Los Angele s Cal ifornia 90005
De er wr, Robbns :
in answer to Jotr letter July 2Oth,
we subnit
tre folloming:
Re / Clai: o2x 2034/+5
clainant Sirhan Sirhan
Date of. Injcry9/25/66
The Claimant w2s hirea 6/2/66 "258.00 Per #o _
Raises : 6/26
L. v275.00
7/31 #300.20 " "
8/21 #350.00
9/18 '375.00
Total 'azes Faic 81797.56
Loeft employ 11/13/66 volunt arily for other empe
loynent
Returnad {0 work 12/1/66 voluntarily
~ #375.00
Loft omploy 12/30/66 volunteriky for other emp-
loyent_
Wa have no kmnowledG0 of previous injuries .
Sincorely yours:
K8k* Xa ZhRt _
Altfillisch Con:truction Co .
B3A / Cranj e V:*8 De 1 Rio
Acc /1J}
8K
July
Co ,
kh k #8 .
8Q2
==================================================
Page 24
==================================================
LEC4l PREMRAROM SWRET
CLNIM No 92x-202465 1y4 TOfA: MEDiCAL PAID_
12,J8 OF !Njury)
ClAIMANT'$ NA,ME Siwn" StE TOTAL INDEMNITY PAID
NAME Of ASSUFED_ ATZILlISELCgle CQ WEEXLY RATE
PEricds COVERED
ARVANCES on P.D. or C. & R
Indiv duol Lo-puftnership
Corporaticn Joini Venture
OLICY PERIOD_
I1is6-61 PRODUCER WLLZR &_A:Q7_CALLR
Apparen? Rexscns For LiNccmo? Preparction For Kearing
icircle Number Of REASON 349*1
Comzensclion nof paid because 0 _ Date Kedring Set_ 40
(al No einployer' = report
(b) No doctor' : report IAC No. UNKeOiN ` ii
2. Femporary disability terminated by
dostor and clairian; discgrecs Dale Application Rcc'd_L4LLbZ
'Fernanen: disabilily prematerely.c'&itced
4 Kdvisoiy rating fcr P.D_ nof acce platle Date File Senf to Counsel
2 Further mediccl sought by employe? Has medical been filed with
Commission arid served?
6,' Injvry A.O.E: and}or C.O.E
Further mediccl:
7 : Statvfe of limitations
1 Nof necessary
8 Caverage for employe; or #his employee
9 Employmgt of employer identity disputed 2; You urrange_
110. Cependency 0; idenlity of dependents
#1 Olherz
3, We Kuve arranged
(a]" By: Dr _
(b} Date:
Is case otherwise ready
for litigation?-
RENARKS , BY CLAIM EXAMINER:
'gona66 Jneaensce TCoifnny
(CLAIM ERAMINE Q
(Do Not Write delow Tkis LiNE)
1250*25
Uvcen Red
2 circbily
3 Medcal
'njuiy
5. Stctute
6. 'Earnings
7 Occupotion
8 Coveroge
9 empieyment
10. Dcpendercy
1 1
803
Time
Liigurcn Mictk 9v4c*
Dolc Win:s35
==================================================
Page 25
==================================================
PALMER AND TooMER
KTtornEYS AT LAW :ELePmc~E EAnEsT L ^LM[a,JR
AAN: P,{oomER Citiz €N? 8AN < auilcing 196-2:€
604-2J2 : 16 NoATh MARENG0 AvE NJE
PASADENA CALIFORNIA 9i101
July 10 , 1937
WORKMEN S COMPENSATION APPEALS BOARD
4107 Los Angeles State Qf[ice Bui
107 South Broadway
116
Los Angeles
9
California 90012
Re : Si,nn ", Firh;u 177 Granja Vi.:ta Deh Rio t +'
Gent lemen:
Please file che items which have been checked below:
(7) Original and copies of Application _
( ) Please set this matter down for hearing_
) Please place this matter on an off-calendar bas is
Certificate of Readiness _
Medical report of M.D .
9
dated
19 together with his Statement
in the amount of S and his Notice and Request for
Allowance of Lien.
Copies have been served as indicated.
Very yours
PALMER AND TOOMER
By_
Arxr:: P . Toorer
CC :
ARGON:UF' INSURANGE COPAiY
804
Zh :0
6 %4./,1 ding
{L( ?
bi $
truly
==================================================
Page 26
==================================================
ARGONAUT INSURANCE
To FROM DATE_
222
19
INJURED Policy
INSURED_ Policy TERM
CONVERSATION with 1e0r1sg_ CLAIM
223'L
K 4_Kze ZeEsz Zoszz
C 8 9 _3032
237
CYz
221
I6WVe_2Zosn =
FeL_ZLeZ
Zzu/_
22
805
CLM5-7 R-i
Cu
Keen 7
287 Cxa
==================================================
Page 27
==================================================
Tynt 1 Iccustrta} Rclaticrea
XD CAUSE 4PEARING:
A ck Eadtusisl Accumt;
sPplication hercin Workrcs"
5 ~oirpexsatior Agyala Boara
"c Of: calencizr.
Sate 0f Caiifornia
ApplicatrcN
DAc 70 {pjunicarion Cf CLAin
CASE No.
Mle stgrc& crlgiseol st copich
nt ar !yne Kenncs Gud sditesses
SIRHAN_By SIRHAN 696_East_Howard
4i4DD LULOUL INJUFID { BTLdtee $ AodcERS)
ecurity No_ Pasadena,_California
'Atrliclmt_ WOtng? TMan [HJured [MTLOTIt} (ptlicant $ Xddncis}
YS.
'JA VISTA DEL_RIQ_ Box 152B Rouce
(EAPLOT[r) ({eFldtee { IODPISI /
Corona California
NAUT INS JRANCE COMPANY 1001_Wilshire._Boulevard
{{0tici 5 insdranc aRET 03 IT672 i Selt.IYeut[? Qt IAODRESS 0f InsufiucE Ci2nir"4
7u8 Uhisurid} Los . Angeles
9
Californiz
[CLAJMED THAT:
he injurcd cmployce, born_3-19-44_
#hikc cmploycd 3s < exercise
(DAte 0f ?ictX| 'Ocutiticn At TIEI 05 IRJCRT ,
In
9-25-66
3[
Corona California.
by thc employer sustzined injury xrising Qu{
DAte 0f inJuRY ! (city1 ISTaT)
Iand in thc coursc of cmployment I0
Jeft eye lower back
STat[ aa Pfts Or Bo0t TeRe iiurEO'
"hc injury occurred 4 follows: thrown Qff_filly_while_exercising_her;_breezing her
({Iplain Hhit Erelotei Ma} Ddiag K Mid[ 0f iHuat (") How Irju' TTr([ ?
t full s2eed
Ictual carnings & time of injuy Wcrc:
8375 per month
(Gini #[IL J0 Vohtalt WLart or Kourlt Eiti Rn] WdogIR 07 Moua? #ore{d fIr #!'
(Separatelt Jtatl Yalue Ptr Jfer cr Mouth Df Tips VEIL; Locging Or Otxer ADvintaces RIGuLiolt ElceiviD-
hc injury causcd disbility 2s follows: yerious periods
(Sriciti (aS' OFt OFt #ork Oul To Tkis injurt AMd Beginning X40 [Md,Ks CFTIS 0f AL FR;os C {{9 J F0}T3
omjensation 7a8
~(TE:) (Ho , T2TaL Daid , (Wefelt RATI, ID4f{ 0f Last PatrIst
Xedical treztment was rccciyed 4-6.62 All creatment wz5 furnished by tke employer 05 insswrzace
IYIS } (#o DATI 0f Last TPIATUIXI
'ompany other (rencrcnt FZ; provided 05 (or by
I{> , (hO ) Mac[ Perior 0fAGuRct Tbovicing Or Patihg 70r REoici (rf
)cors nof provided or for by empcyer or insurincc compsny, creatcd Or examincd for this injury are
(SitE Here}And Adcrisses 0> S"sk doctoms Ad #A#iS 0r /05?u1413 10 #mch SucK Dociors KOmittio (#Jueed,
Unemplyment Insurznce or Uucmplcyment Corpensation Disability benchts have been received since the date &f injury
Other cases hzve becn filed for induscria} injurics by this cmplovce as
followwone_
Sccint Cist Guku[" 'r) (171 CT "i;
This aPplication is fled bccausc of
7
disasrcrment regarding liability for: Temporary isabilicy indemmity- Perniansnt dis-
bili:; idtrzir;; X Rersursc:rana {0" #cdicil cxcons;_ Motiira} trMtnc? X Compensation 2t prom"? rJte_
Dcher_ Srecify:
and aPplicant rcguests 7
hzaring and awird of tne sxipe, nnd for 1/l other appropriate bxnefts' provided by Izw
Hcaring requested at
Los Angeles
Datcd Ji
Pasadena Californi:
July_lQ, 1967
(citt > M[
Numtx: of witnescs Prc-Eri:l wanted
MC) Xo , j"Wi
uehst :
Esrimated time of tria SIRHAN B_ SIRHAT Jcist {{i6hatvri
Set now
X Si Jarcr On written rcglc: PAUER 4 TOO Ew-ett 46{Cr"
16 North Nareczo 4ve Pasadena. CaU.
:c' 4 Jct Tut
$ 654-2030
83x
boy
Pzid
paid
Peid vho
806,96-2086
==================================================
Page 28
==================================================
ARGONAUT INSURANCE
To_ FROM DaTE IS
INJURED POLICY #
INSURED_ PoLiCy TERM
CONVERSATION #ith CLAIM
O{/
Z0z ezez
907
Clm 547 R-1
LhuJA
==================================================
Page 29
==================================================
ARGONAUT INSURANCE
To_ FROM DATE 19
INJURED POLiCY #
INSURED POLICY TERM
CONVERSATION With CLAIM
834
Xez-PEccp
[ns ^
808
==================================================
Page 30
==================================================
ARGONAUT INSURANCE
FROM DATE
4723
19
NJURED PoliCY #
INSURED POLICY TERM
CONVERSATION With CLAIM
212:5
78
803
CLM 547 R.|
==================================================
Page 31
==================================================
FOR THE ATTENTION OF REPLY REQUESTED
WRITE IT
Jon t Icb
FOR CORRESPONDENCE BETWEEN DEPARTMENTS
SUBJECT k Ke- (. DATE
7Z37
JL
s71 &7 & 327-2 4274 24~2 V
Iz0)
f<
44S: 74247 fp+ exez/ 342849 Lrh6
2z4 `2 4 2_2
Y Lzea
2zs"
Z r eeke
&z,
1
7&z }
le&t- 2z 77
144@
92ly<<
GMANJA VISTA DEZ RIG
XI; 1 Box 159-B
CQRONA, CALIEORNIA 91720
BLAcK CAT FORM 228 83
81
Say
2~ ~te
toz
Csigned
==================================================
Page 32
==================================================
cdrgomarck 8sulwte 6oefaies
April 21, 1967
Mr - Sirhan Sirhan
c/o Route 1
Box 159B
Corona , California
Direct REPLY To
Office CHECKED BELOW:
"250 Kiddlefield Ro4d
MENLC PARk, CalIF.
94025
550 CALIFORNIA StReet
Say Fraycisco; Calif _
940,
{{J Stiatto PLAcE
Los AKceles Calif.
50m5 RE; Claim No. 02Y 203415
Jso Vista AVE. Dox 4205 Altfillisch Constr. Inc
Boise, idaho Employer
03705 Sirban Sirhen Employee
7600 CaRPEnteR Freeway 9/25/66
DALLAS TEXAS Date Inj:
1524}
Northwestfrm Bank Blog.
XimneaPolis; Mimheso;a
55412 An appointment for speciel examinetion has been made for you on:
271 HioRTHLA SaLLe ST.
ChicacO, ILLinOIS
Io6di Date
Friday, Mey 19, 1967
Su4SOUthweST Sixth Ave
PCRTLAMD, ORECCN
51304 Time 10: CO AM
Mi80 Raykohd BCULEVARD
NewaRK, Ner JERsEY
07 102 Office of: Joba T. Garner, Me D.
1422 #est PeaCHTREE St.
AtlanTL GeorsiA
744 Fairmont Avenue
3037i Pasadena California
NET GRAYANS { A Phone:
"681-7028
7013
Please make arrangements to be present at the appointed time_ If you are unable
to do advise this office and another appointment will be made for you:
truly, ygurs;
Robbins
CLAIMS DEPARTMENT
Cc: John T `Garner, M. D.
CLM: 1212.R2 811
Co:,
S0 ,
Very
==================================================
Page 33
==================================================
Atamecunk <rssutace GBomfunies
Argzl 1C6T
2180 832223 &80410
0o Bors %
Ix2 1593
Gorouc, Calizormio
8g2 2jQn
2390
9/as/c
#3s8, Bz 199 1931
30,02 83
3ob3 2
Cadt32- B Dc
8 Bals man 7X Ev0nt
CB C01820178
4nr39 681+7023
Ba % Zaob209
088 Join #o Gzntz, Hlo Dq P. Sa: Restne enclosed. Please examine, ana
forard fQu", cories 0: yQul' rapord .
1(
812
219
ee+@
Culel
0 0 DJ
==================================================
Page 34
==================================================
E.Gordlon Kiekn, M.D
SJiTE 203
4 8 NoRtFi 6l MOL'No AVENUE
PASAOENA, CAL'FORNIA 9m0:
TELEPRONE 442 - 6494
April 1967
onaut Insurance Company
10 1 Wilshire Blvd ,
Los Ange California
Re : Mr, Sirhan Sfrhan
Gent lemen:
'ir , Sirhan caie to this office on February 21 , 196? havins bee: ?
referred to mc Dr, Xilton A. Miller of Orcario, Fhc history of :ke
casc as I received it from che pat ient is bri as follows:
Che pat ient exercised the horses at the Granja Vista De Rio ranch
in Corona On Seprember 24, 1966, he wa$ tthromn from his horse and suffered
injuries around thc left eye , He thinks he was uinconscious for 3 brief
tine He was seen at the Corona hospital by 3 Dr Richard Ne lson and -he
wound s around the eye Were sutured e In addft ion to the around rhe
eVe he" had 3 under che chin, Chi s was also sutured_ 0 Four
later the sutures were removed _ Ke suffered 2 brief injury again a {-4
after he initial injury and thc wound edges separated a ittle bit,
He wa $ unaware of any eye problems untfl he began` exercising the horse s
egajna He noticed at this tme that he had co move his head from left *0
right in order to see we 1 1 on either sidc Chis loss of side visior has
definitely i mproved but he stjl1 has some difficulty . Fhi s i5 cspecially
noticcable in che le ft eye . Because of his eve comp laints nc 27* refe-re:
to a Dr , Ne lson of corona and followins; :}:; ~{I:0n ~ller 0f
ntari00 T do not mave Dro .iller S reports so I am unaware of exacr ]v
wh;t Ha: ?i "ings we re , At the present t ime 2is 0 Sirhan S complaints
primarj ly arc as follows:
Ke notices that he has some cwitching Gf the eyelid vhen he looks
0 the le fc This involves the left eyelid primar! He also as rhe
samC type of twitching when he wrinkles his forehead or makes facfal
movemcnts, He has had no SU oseguent unconscious attacks, no d!zz iness,
ro weakne ss of cither arns, hands , legs or feet Me complains 0f 3
persistent pain in thc supcrlor nasal aspect of the left orbit, Yy
cxaminat don was 85 follows:
His vision was found to be 20/20 in either eye uncorrected _ 0 Se had no
si ficant ro fractive etrore Extraocular muscles were found ~0 Se :ntact _
813
b $
Ars
1es,
by
efly'
wound
wound days
Aays
1yo
ni
==================================================
Page 35
==================================================
#fordon Kici",
Arzonaur Insurancc Compar:y Page 2
the pupi 1s vcre round , pe Te regular
9
and reacted we ] 1 ro 1: and
accomodafion e Che pacicnt's evc $ wcre dflated and an examinarion of he
fundus KJs pcrformed . Xo s1 ficanc abnormalities Nere iound
axamination vas performed both with che dfrecc and indfrect ophrhal 7
moscopc . Si} lamp exanination showed no flere or cefls in ei-her '61e.
Both lense s are clear an / che med i a eppeared clear. Vi sual field
cxamina-ion Indicate s a full fleld vith 2 nodercte amount of" gener2l
cunstti-ion in che left field. Thi s constriction is Gcors a7
pat ient $ rounds are we ] 1 healed _ honever chere Js a persisre:: feNrnes?
over the superior orbital? rldge med ially' and Ehere is 3 sina] I 2mous- cf
fullness in this area rcma ining. The tenderness is w2dial cO the Supra-
orbital notch and i{ ~pprently agsravated when che pafient looks bo-h to
che cft and upvard co rhe lefte Chere is a fibrocic hand exrending {rom
this general area dowward Lo the area just be Lou che loxer car-hal
ligamento Ke claims cha: thls makes him have 2 rather fichc Sensa-io5
when hc looks Lo the left: I could demonstrate no abnorna ! :iplo?la,
in fact my findings ere remarkably negative wich che excepcion of Fte
cenderness and che subcutaneous band vhich I inent [oned. Ac ch: pre sent
time , [ do not fcel 1ike operating on the area which js describcd, and
re leasing this band_ 1 feel that Ke shoula wait for 8 period of 2bouf
one Mon:h yet_ 9 AC che t {me of releesing this subcucaneous band I be lieve
ic would be advi sable Co inve st igate che origingl wound area for che
possibi lity of a foreign reaction giving him che persistent
Khich he f2els and i5 described above X-Rays ordered by mie have indfcared
no evidence of 3 foreign body , no evidence of any fractures in and abou:
che orbit , said X-Rays are essent Tally negative The X-Rays Rere Eaken
by Dr . Robert Freeman, of this addresso I she 1 3 see Xr , Sirhan again
anid repeat visual field cests to make sure that chere is no recurrent
abnormalftyo Inasmuch as he Was unconscious and had not been seen by a
neurologlsE 01 a neurosurgeon I be licve i[ vould be advi sable co heve
him seen by 2 neurosurgeon co rule out any damage co che braln tha : mighe
nave occured at the time o€ this injury. I have usually refe-red T
pat lents Eo a Dr , Robert Fisking of 960 E. Green 9 Pasedena Pe < 3
we I-Jualified neurosurgeon and ff have no objection I Vou14
respectfully requesE your referral of Nre Sirhan E0 Dr < Fiskin for such ar
evaluation.
1 crust this wili 3ive you an up-toedate accounting of Nr. Sirhan' $
problems _
Sincerely,
EGK:ra E Gordon Kichn
814
ght
gni
body pa n
and
St .
you
3
==================================================
Page 36
==================================================
DoctoR'S FIRST REPORT Of work INJURY
Immodiately afler first oxamination mail ono copy directly to Sho Division of Lobor Statistics and Rosearch, P. O. Box 965, San Francisco 1 afd '7a EzF {
thc injurance carrier. Failure to file reporf vith #he Dirision is 0 misderounor. (Labor Code, Sections 6407-6413.) Answer all question; fully:
INSURANCE CARRIER Argonaut_ Incurance_Company 1001 Wlgure Blvdgs Los_Ange Calif
30 No: Write
TN IS Seaz
1, EMPLOYER Granja_Vsta_DeL_Rio Afilllsch_Const Company
(No.snd 2. Addross Stoct) 13200 CLErus_ Corona, CaLf _
3. Businor: (Menulacturing shoas, building construction Rench
rotjilina men , clotkas, atc.)
4' Employee 65t
0
srhan_Sirhan SS. No PII
nama)
5. Addrbts (d 696 E2 Hovard_SEe Pasadena,_CaLLfornta
6. Occupation Exercl ses horseg 22 Sex Male Marital Status Single
1 Dato injured e 24, 1966 Kour_72304_ M Dalo last worked Qff IHO seeks
(No 0 . Injurod af and Cifr} LErUS County_
9_ Datc of your (irst eraminatioFeba 1967 Hour_94OQA M Who engagod your serviccs?MLLEOn Ao_MLllez , Onfario
10. Name other doctors who treated employee for #his injury Pichard NeLson__HaD c
M1_ Accident OR Exposure: Did employee notify employor of Ihic 7
Yes Employce $ statemenf of causc of iajury c:
iliness:
Was throw from horse Fhf Ze exerci sIng same 0
12. NATuRE AMD EXTENT Of Injury O2 DiSEaSE (Inciude Jll objective tincing:, subjective complaints, &nd diagnoses I occupatonal disedsc
statc dale of anjet, occupationjl history. dnd erposurcs )
Please see attached reporto
13. X-RAYS: By whom talen? (State i nonc)
Findings: Negative See attached report o
Fobert Freeman , b8 Nc El Molino Avec $ Pasadena, Califo
14 TREATMENT:
See attached reporto
15. Kind 0{ cose (office. homc, or hospital) Office hospitalized , datc Esfimaled stay
and address o/ Hospital_
16. Furthor Irualment (estimated uency &nd duration) See atteched repert
17. Estimated poriod of disability {or: Rogular Nob_disabled_ Modified work
18. Doscribe ary permanant disability
or disfiguromon} expcctcd (state if none] See atbacbed_xeporcc
13. Mf dcatk ensuod, give date_
20. REMAR*S (Nolc jy pre-cristing injurics or discdies, nred for Ipecial cramination or laboratory fells otfer Perlineot inlormetion )
315
Name 50
GordlonKiehn,_NsD: SGRSONAE
222)
4.
{Typa cr Print) 0f Dociot
Dete o report_ 4-262 Addrcss (No. Stcc; Jrc Cily}_ 48_N Roxtnc#v2.
Pasadenas_Celuiornia_9UOI
Jl #Se ReverSe Side if More Space Required FIRST REPORT
Do1 Ial L.
les:
Cily
middlcr
City_
Age
Sep_
8i3200
2L,
injury
Mo Do ?
Namo
{roq
work
L0.
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Page 37
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DocTOR'S FiRST RepoR
FILL OUt AND OF WORK INJURY
FORWARD coPY
4 02 X -
IMMEDIAtEly AFTzr DtXEOP GiLiornIA
First SEEING
PATIENT
Alco , Izic-taioty aftar finsf oxaminaiion mail ono coJY direcK; Io Ihc Division of Labor Stalislics ad Research; P. 0. Eox $65, Szn Frurcisco 98401
Failure to fle : report with the Division is : misdcrneanor. (Labor Codc, Sections 6407-6413.)
Answer all Grestica: fully. 42303423 3SZ4E9e 1021 Wilabige_Eleda Ezzicg
R
G2l420
Do J05 Drit
1_ EMPLOYER Grca ka_Einca del 89 4kdtilisch Czuitee io 03,pcc
2. Address {a '86 2az 1583 8 2 SQEas_dnlizonta
3. Business MIEuocHHliiteg:084/ldine 58
E({ Den" 5 c lcenos_ [LE ochal YecurITY 76.
4EMPLOYEE (Flrat ntoe olddla 3136.31&32
Ipetie1. Ltt 02mo)
S. Addres; {N8ti,ft 696_Exc_Ezerd Feoedara Zezi
6. Occupation EcxRA8zn1nae Age- Sexbala
7 _ Datc injured Q_%E26 Kouz_Di?LA_M Datc last workcd 0 8
8 Injured ar S"etiet Gn_*2 Sob County_
9. Datc of your frs: examinacion_3212 rou- 9032 Aa M Vka cngiged your services?
10. Neme othcr dcctors who trcated employce for tki: injury
11. ACCIDENT OR EXPOSURE: Did employee nctify cmployer of this injury? Iza Employee's scatemen
of cause of injury or illness: 1 [Z9 G*n Esa 8238 13zeo €3io Cozozego
12. NATURE AND EXTENT OF INJURY OR DISEASE (Include :H objective Einding , subjective complzints, tnd diadncsea
Jf occuparional disease stefe darc o onecs; occupiriana! hiscory. and cxposures )
Lzeorcezcn 02 Loge L7pos 0913 %4c: Bllerezel {oro35a Ezdics (ezai} {p C7?6
locczaclon 0f ehsrp 8o-32ox, 3 cao €oza? bagth; Icn3p Ccatuoica 02 82323032
bece; €zz342m8 ccacesicn O2 Zafe hnid ard Eslesplo c3C31c390
13 . X-rays: By whom taken? (8L246 I( 0c59)
Findings: Wefotiv? Eor gceeBecO.
223*30227 e278 0: go41 C2010 @ Dja2c3 0387o; a
14. Trcatmene: Zoccl 0nczchcoso} Eolone:on Csz Falc; bocple lecad S83 Eusebcz JC3O
834 cbeczva6iCil,
15, Kind of case 8Oe toRc Eegieal @CZEAc82 If hospitalized, date
Estimaced stay
Nenc 2ddrcss cf hospital_ C3zora 647nigz 7c204eal 02} B2ze 350 2 G329
16. Further trcatment (Allmstrd (tcquency #ekl 4E2o 3lle%or 6nE 2L cr 20 223222332
tad durellon }
17 . Estimated pcriod of disabilicy for: Regulsr work 65 6_Ecetd Modifbed 3 Cc23
18 , Describe any permznent disability 0r disfgurcment expected (8unlj I(nanc ) Eoza_ 03E Enenzgc
19 . If death cnsucd, give datc
20. REMARKS (Notc any prc-cxisting injurics Or diseases, ncccl for sprcial cxamination or laboratory tcsts, Uther pertinet info ration )
31"823ZN 043 R1-03272
BAEIIZT @BNREED To DetICK Pan@ Nj33C8 p Bcdo
N 3.ONLY UNDER EXCEFTIONAL CIRCURSZANCZS WILL 4 HERNih 32 CONSIDERED DLSADLING PRIOR r0 OPERATox.
TRE INJURED SHOCLD BE {DVISED To CONTOTU: VORK , IF POSSIBLE, UNTI NOTIZTED TXaT RIS CLAIK IS ACCEPTED:
Name_ Ricbard 0 Nelcor, 36 Da ferconal
(Fsoa or prlot)
Degre? si388cv85 3-818
Date of rcport 28c8-8S
Address N_ 0
715 8. Wanbira (;8 895on, Cala&a
Tcl, No
Cl)
Fo7i; 1o €.8 Use reer"sc E co ef sete #psco#E:17o2
2 034y1
C22
Am
5o and
work
==================================================
Page 38
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216 - Slyr 70
~OBERT G_ FREEMAN, M D
JOHN D_ RUTLEDGE, M_ D
21775
48 NoRth EL MOlino AVENUE
PASADENA, CALIFORNIA 9n0i Merch 18 _ 1967
TELEPHONE 795-4381
RADiOLOGY
YtxS To
Argonaut Insurance Exchange
1001 {ilshire Blvd,
Los Angele8 , California
FOR PROFESSIONAL SERVICES
RE: MP = Sirhan Sirhan
696 E Howard
Pasadena California
EMPLOYER: GRANJA VISTA PEL RIO
k04_
32100 Citrls
Corona_
9
California
INJURZD: 11-66 At work
REFERRED BY : Eo GoKiehn, MoDo
3122
48 . Ne Z1 Molino
Pasadena, California
K-RYS:_ 2-21-67 Left Orbit #7019 816 . 50
817
3/
2807 20
622
6.6, -
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Page 39
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SYCAMORZ 5-4381
ROBERT G. FREEMAN, M.D_
JOHN D. RUTLEDGE, M.D.
48 NDRTH EL MDLIND AVENUE
RABADENA, CALIFORMIA 51101
REPORT ON ROENTCEN EXAMINATION
oF Ho SIRAEN SIREAN'
AT THE ReQuEST Of Bo G. Rlean , B. De DATE Feb e 21 1967
9 48 Wo 21 Molico 9 Pagadena
LEFI ORBIT & ADJACBNT TRANTAZ 'SINUS :
Tn8 {1lng proviie nO Gridenee 02 bone Injury involving
he Zefe Orbic G% pozs-crbizal ceelctures .
M:C:
John Do_ Rueledge , %i6 Do
4
83
Thib REPCRT /5 [ASE) Colcly UpoN TKE RADiDLOGiCAL Eximination
17 cyaminatinN |3 EeUENTIAL
IedAd
==================================================
Page 40
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CLAIM ROUTE SLIP CLAIM NUMER
K-J
Send file co:
Supecviaoz Checkwriter Resezve € Cloaing Clerk
Clericel Superwibor Bii? Clerk Coverage & Conerol Clerk
Esanlue: Ll uake-up clerk 0
File Section
Indemnfcy Clerk Legal Clerk Central Control (Accouneant)
Instructlons :
Coo and dlary Ei Make Reserve Change Prepare & Send
legal f1le to:
Elgure Awara 6
1I Hake ReopenLrg
Counsel
C & R Ti Make Up X Case
Subro . Counsel
Travel Exxense 1
File Corgespondence
Bi1l Comolete & Send Fed < Porm
Cancel I Stop Bayment
RZMARES
Dace BX
ZZS
813
34/45
Pey
Pay
Licgo
Pay
Pay
Pay
==================================================
Page 41
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~dgomtak -rsuehcmce nfanies
Mey 2, 1967
Mc Sirhen Sirhen
c/o Rt 1, Box 159B
Corona, Californja
~Lt
1 + 1
DIRECT REPLY To
OFfice CKECKED BELOW:
250 Middlefiel d ROAD
Metilo PARK OLIF,
94075
Sso CALIFORNIA StreEt
Say Francisco, Caif
9410
14J Shatto PLAcE
Los ANGELES CALIF ,
900c5 RE: Claim No. 02X-203445
[J50 Yista Ave: DoX 4405
BOISE; IDAHO Employer HIOISCH CONST _
0
COa IC .
53705 Employee SIREAN SIRHAN
1603 CARPENTEr FReeway
DALLAS TExas Date Inj: 9/25/66
15247
Horthwesterh Ba4K BLds.
MineApolis; MINNESOTN
55402 An appointment for speciel exemination hes been mede for you o:
221 NORTH LA SALLE St,
ChicaSo,ILLINOIS
60501
S1: Scuthvest Sixth Ave
Date Tuesday , May, 23, 1957
PORTLAND; ORECCN
97204
11E0 RaYhonD BOULEVARD
Time Il800 AoMc
NewaRY, New JERsey
07.102
1422 West PeaCHTREE St.
Office o: Semuel Weaver , MaDo
ATLANTA, Georgia 1125 E 17th St
3o30p
539 GrA Vier sT.
Santa Calif
N# OrLEaNS LA. Ehone: KI 2-7489
Zdir
Please make arrangements to be present at the eppointed time. If you are unable
to do S0, advise this office and another appointment will be made for you.
PoSo Pleese disregard letter o2 4/21/67. The appozntment has been cancelLed
truly yours,
m
Ro J , ROBBIS
CLAIMS DEPARTMENT
cC ; Sanuel Weever? MoDo
820
CLM-1912-R2
Ana ,
Very
==================================================
Page 42
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edngomasd Ibuunce Bonfvaies
K
043 SHATTO PLACE <
Los ANGELES, CALIFORNIA 90005 U
U.S.pOSTaGe}
<
MAY-4'67k
0 5
838 CALIE 'PDE43659 8 T [ R
3
ML
5
HHhI
P--I
5 3
804
E8O
7
Intis
8
1
6
pnGeLe
[
2 2
1
0
cLL
Zxaseun
iaz CL _
==================================================
Page 43
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ARGONAUT INSURANCE
To FROM DATE_
4zz
-192
INJUrED_ Policy #_
s/hai STRTKN
INSURED POLICY TERM
7h4f5
CONVERSATION Tith CLAIM
22.3/15
322
Clx: 547-Ri
UL
141
==================================================
Page 44
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DOSTOB'S_FNAL _{QR_MONTHLY) REFORT_AND_@ILL
Iamizod bills, IN DUPLICATE are to be submixed af #fe #crrination of #He case.
Monthly statcments
Crq POSITIVELY requirec/ on casos under treatmont:
Mail *o Argonaut Insurance_Cempany Address 1001 Wilshire Blvd Los Angeles, Calif.
Services boginning lato in month and crtending into succeeding month may bo ixemized on ono staxement:
EMPLOYER_Granja_Kista_Del Rio Altfillisch ConSa_Cqnpany
EMPLOYEE Mro_Sichan_Sirhan
DATE OF INJURY_ 9-24266 SERVICES FOR MONTH Of AprLl 19.62
Patien? roruscd trcatmant Porient able Yo roturn to work 19_
Patienf stoppad treatment Patien? discharged &5 19
wishout orders 19 Condition af time of Iosf visit_
Patient enterod' hospital 19 Notdischargeda
other charges euthorized such 0s Drugs? Hospiral?
{Chock} (Choct)
Code: O_Office; V__Homo Visik; H_Hospikal Visik; N_Night Visit; $_Operarion; X_X-Ray:
Monta 2| 3 45 6 7| 8 1ol f1 12/13/ 14/15] 161 17| 18| 19/ 20121 22} 23| 24| 25| 26| 27| 28| 29/ 30| 31
Totals
Firs? aid troatment (describe)
OKice Visits 4-6-67 $ 5.50
Kome Visits
Hlospital Visirs
Opcrations
MATERIAL (#kemized a* cost} 50
5050
chargos shown aove which aFo in excoss of the minimua {ce mus} be oflained below regerding nature o such
services, indicering #nc dare ronderod:
Make check payable to:
Doctor Es Gordon Kiehn_MaDe Signature
;;
t8
Addrass 48_NEl Molino Ave 0 9-
Suite_203 Date May -4a 1967
Pesadena, California Q1121'
223
Soiacti
P.o. BOX 18248 1"" Form D-16
2 ;4d
cured_
Any
22125
2oTAY
Any _
==================================================
Page 45
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DOCtQr'S RnAL_(O1_MONTNLY)_Repobt_AND:BiLL
Itemized bills, IN DUPLICATE, aro"to 3 suSrnitted &} #he torinination of #he caze:
Monfhly stetements er8 POSITIVELY requirec on cases under Ireatment:
Mail t0_Argonaut__Insurance_Company Address 1001 Nhilshire_Blyd ,_Los_Angeles
Services begirning late in month and ertending into succeading month may be ikemized on ona sratement:
EMPLOYER Grenja Vista Del Rio Alcffllisch ConS. Conpany _
EMPLOYEE Sirhan Sirhan
DAT? OF INJ'URY_ 9-24-66 SERVICES FOR MONTK OF_Febe & March
Patien: rerused {reatment Patient abla *0 return %o work 19
Petient stoppad treatmonf Pafient discharged a5 19_
wixhouf ordets 19_ Condifion & timo o} lasf visit
Pofienf enfered hospixal 19_ Patient 'st1ll under treatient.
other chargos authorized such a5 Drugs? Hospital?
{Chocl) (Chace)
Code: 0 ~Oxice; V_-Home Visit; H__Hospital N-Nighr Visik; $ Operation; X-_X-Ray:
Month 2| 3 4 5| 6 7| 8 10| 11 12/13 141 15 16/ 17/ 18/ 19| 20/21 22| 23| 24| 25| 26| 27 28 29/.20| 31
Febe 0
Marce
Totals
First' aid #reakmert (describo}
Office Visiks_2-21, RvS 0002 0
S550 329 & 3-23_ RVS 9004 0
S5250 9 S66200
Homa Visits
Kospital Visiks
Operations
MATERIAL (ierized a* cosfj
TOTAL 66,00
charges shown abovo which &ro in excess of the minimum fec mus: be explained bekw regarding nature (of such
services, indicating {he date rendered:.
Mako check: payable to:
Dockor_ En_Gordon_Kiehng_M.Da Signaturo_
Addross_LB_N_EL_Molina;_Suite 203 Dato 3262
Pasadena, California
824.
Sren
r,o: Dox '1246 L Form D.16
1987
curod_
Any
Visix;
002 eee
Any
==================================================
Page 46
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ARGONAUT INSURANCE
To_ FROM DATE_ 19
INJURED Policy #
INSURED_ POLICY TERM
CONVERSATiON With CLAHM
325
Cla: 547-Ri
==================================================
Page 47
==================================================
May 2p 2967
E0 Siatan Srhan
c/o 1 20 Jar 1591
Cor0pzp Cnl1ft3n%0
(2K+203445
ArIzJLIO CCMz : #0, J#C .
SINE;; SInAn
9/25/8
Euxcieys %iay 231 2967
3.00 Aaaio
Se7wel Nesto3a RoD}o
1125 % 17eh 80
Sarte Gal4t .
F002?} 2 2789
PaSo Fleese dlcncparl Jotbar 6 4/21/67. 03 cypofrtant baa bcca 62284238d
0
2 Jc 2H30M
cc} Sczual WCZinet , ZioDo_
PoS< ESuzo Grelccet , Plcacc czzine #rd CE2;
Qp 0ry_balzo problors %&3t Eay azlabo
PLZASE FOEZA RD FCUB} COPIE 0g YCUR BIFUnr
828
4A 2
==================================================
Page 48
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WTURmmEN ? CYMCONNOAUVN AntLnty JUAXU
STATE Of CaLiGORNIA
ANST 0f ARTGNAUY INSEANGE Ary
c708 Ao 9323#8}_ovec, Case No. El-Ectee:-7o20-67
~696-Bo #ovrrd, Dale of alleged injury: ~9/35465
YS.
ALESTLAESCK CCiETr"GTIO
VrSre /rU c3rtoflo) #cx 150930 Rta-8 o Ggrora; 8airf,
ARC6M6
Tco
643 Bhatto
Inge
7M24,318+88 0 k€2
0
(CIRTIFICATE KungER [F ScLf-ihs~rEd)
ANSWYERING DEFENDANTS the allegatiors of the Application as indicated below with such explanotions as ex-
pressly set forth and adrit all other material allegations.
DENIALS" EXPLAIN BELOW:
(HarK > IT Allegation i5 DEHIED)
Employment
Occupation
Injury
(If Denial [S BaSED O# OaTe Or Part Of Dodt ixjured, Explain FuLLY)
Insurance coverage 48733000380
IFe"FlcYiz KisolZk Notified To Afpear ARd DE FEXD}
Licbility for self
procured freatment
Liability for future
medical treatment
Medical-legal costs
Earnings
Periodls of disability
(GIvE LaST Day WorkED Ahd CorRECT date Of RcTurn To Work)
Permanent disability
#Faxfonrent ,S claiked, 50 StATE)
It Is FURTHER ALLEGED:
1 Defendcnts havc disability inclomnity in tho total arounf of af the rale of $ wcek
beginning through ~plus_
2. Affirmative defenses and other matiers:
Defendants do nof waive the right t raise additional issues in accordance with Ihe provisions of law arid the; Rules of
Practice if oner issues develop:
Estimated time for tricl: Dated ai 38 00
Californio, "{3tox_
'tcntty All defendcnts. medical reports haye b2en
filed_ #RCUtI
fsuett Additional reports wiil be filed before Hclorghlii; ?n3 Dabey &
trial By:
Cr=
Shljnd 478o0 Zaloe Gallf. 9802
Pre-frial wcnted:
TES Ho Joress AHd Tf[e?hoile Mumber 3 Attsrnev)
Dia WCAB ForRm |0 (REv. 0.C6)
FO?MERLY FoRK 36) 0 Ao
527
8ca
deny
638 ka.c k
paid
(ualog
2'0
==================================================
Page 49
==================================================
PoLCY NNEER CLAMM} NumbeR
Incurrzc DATE LJRE 5f rik MoryR GcrUL DiV: Ltr Serul Class
{Q5Z-65 QQ0 0# 0 210f 056322 02 X 203445 0032
Cony
ACTFILLISC Cors RUCTTOT COIPATY
9
IWC E_
Boz4S9B 2 Cazona Cal4Eoznt RDoz
Miller 6 Axes 0; Calzz
Acc PR7z
E 5 9
7iroz CC3E eX 3625 W , 6tk.Sen 0
Los Engelea , Calff. 0 109-25-66 0 3 0 5715 Jav
01-0656-67 XoL TERN
STRHA7
2
SIRaAW PART
cfo Rz 2 Bor 1SSB 64432*
CAuse
4C,2758 Corona, Califczala
lac ZP . chin br NATNR :hrow OEf horse. Citse 3
Nozcde Calzg RcMtTCM
RTcrsr 4 No_3c7 DCCTOR
Haunat 52.
0
Nore? Carzozzia ADDREs?
I2e,TY KICaI All3r TOTAL_ 8cx?33+72N 2207i 25) 250 2700 REsERZ3
ReSerme CHNGE Abvice
Q RESERVE NE RESERVE
IndemnNEOPENT$
Medical
2
Allocated
Total $
46242 33&
Dafc Division
By
828
cLm-s3
9
OL
==================================================
Page 50
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Pclc}KzUt Gts #US35R
#XCURREC DATE Drk: {orr( S2%; D3e Ltz 801 CXss
1 0-27-65_ Co 20 230 056370 02 % 203445 0232
C3N"
ECTZILZI IROCII < ENC a I,
Box 452336 Corcza C4 {0 AW38
Mller & 0233 02 Celiz
cC %413 PRE 3623 W, 6en Sc
Lo3 Argelef9 Gellee 2-25 6 0 5715 78N7 .
4k5n 2-0x-6c MiTrR
ToJoL1E 81;34 RXI
3r6h0nt 280777p clo Bc0 2 Rcz 1593
96 34se;
77ltF 47573 Corca Caldzcmla
0t70ty tlt77 0ly7 tsisu Lace {3p cnin & 4A7Uz cnsczr QfE horse 33r
t7te] Noste, Cal3} Roae
Kiesazd 07721051
37oe
Ltie7 Trtt Inl Gta Ratzer 80 @ $ AD3 0 Cl: ornla ICORESQ
[Pbnty ~CC? 9480 TOTAL Cuxp2xaanoN ~zzor).
GO
250 ZTM RECzRvZS
CLLOSING AWvied
T0 ta*WLATING DEPART3287'
OLD RESERVE_ New RESERVE
Iridemnity
Mecicc
Alkocc c2'
Tattl
83
Do?
829
Divisicr
CZAJM